Contact Info

More about you

Why are you interested in the Every Body's Circus Program?

Is there any relevant information that could affect participation in a circus class (i.e.: medication, diagnoses, or medical conditions)? Please provide any information you are comfortable with sharing.

How were you referred to SANCA?*

More About the Student

Has this child taken circus classes before?*

Yes

No

Is this child on any medications?*

Yes

No

Does this child have any diagnoses? Please describe

Does your child have a one-on-one aide?*

yes

no

How verbal is your child?

Please tell us about your child’s interests

Please describe any social issues/needs of which we need to be aware

Please describe any medical needs/history of which we need to be aware

Please describe this child's behavioral/emotional history

What would you like to have this child get out of an Every Body’s Circus offering?

Have fun

Learn circus skills

Learn social skills

What helps this child when they are feeling overwhelmed?

Is there anything else we should know about this child?

Phone

This field is for validation purposes and should be left unchanged.

Thank you for completing this EBC inquiry form.
While the EBC programs are on summer break, submissions are held in the order received and will be answered in that order in the fall